Screw head impingement after in situ fixation in moderate and severe slipped capital femoral epiphysis
Screw head impingement after in situ fixation in moderate and severe slipped capital femoral epiphysis
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DOI：
10.1097/bpo.0b013e318032656b
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发表时间：
2007-04-01
影响因子：
1.7
通讯作者：
Wenger, Dennis R.
中科院分区：
文献类型：
--
作者：
Goodwin, Ryan C.;Mahar, Andrew T.;Wenger, Dennis R.
原位稳定仍然是治疗稳定型股骨头骨骺滑脱（SCFE）的标准治疗方法。垂直于生长骨骺板放置螺钉显示出令人满意的结果，并发症最少。严重SCFE原位固定后，突出的螺钉头可能会导致股骨髋臼撞击和疼痛。我们进行了一项生物力学研究，以确定SCFE原位固定后是否会发生螺钉头撞击，并确定可能导致撞击的滑动严重程度和螺钉头位置的解剖结构。在模拟2种情况的人尸体模型中创建股骨颈圆顶截骨术：中度和重度SCFE。我们测试了垂直于模拟骺板原位固定后的标本。模拟SCFE和正常对照通过完整的运动弧进行测试。使用X线透视在屈曲90度时评价股骨头被盂唇覆盖的情况。在模拟中度SCFE中，髋关节屈曲70度时发生撞击，在模拟重度SCFE中，髋关节屈曲50度时发生撞击。前后透视显示，股骨粗隆间线外侧的螺钉头不太可能撞击髋臼。在模拟中度和重度SCFE中，原位固定垂直于生长骨骺板时发生螺钉头撞击。前后位X线片有助于识别原位固定后螺钉头撞击的髋关节风险。替代原位固定技术（前后位X线片上螺钉头位于转子间线外侧）可能会降低中度和重度SCFE中螺钉头撞击的发生率。
In situ stabilization remains the standard of care in the treatment of stable slipped capital femoral epiphysis (SCFE). Screw placement perpendicular to the physis has shown satisfactory results with minimal complications. A prominent screw head may produce femoral acetabular impingement and pain after in situ fixation in severe SCFE. We performed a biomechanical study to establish whether screw head impingement occurs after in situ fixation of SCFE and to define the anatomy of slip severity and screw head position that may lead to impingement. A femoral neck dome osteotomy was created in a human cadaveric model simulating 2 conditions: a moderate and severe SCFEs. We tested the specimens after in situ fixation perpendicular to the simulated physis. The simulated SCFEs and normal control were tested through a full arc of motion. Coverage of the femoral head by the labrum was evaluated at 90 degrees of flexion using fluoroscopy. Impingement occurred at 70 degrees of hip flexion in the simulated moderate SCFE, and at 50 degrees of flexion in the severe simulated SCFE. Anteroposterior fluoroscopy revealed that screw heads lateral to the intertrochanteric line were unlikely to impinge on the acetabulum. Screw head impingement occurred with in situ fixation perpendicular to the physis in simulated moderate and severe SCFEs. Anteroposterior radiographs appear helpful in identifying a hip at risk for screw head impingement after in situ fixation. Alternative in situ fixation techniques (screw head resting lateral to the intertrochanteric line on the anteroposterior radiograph) may decrease the rate of screw head impingement in moderate and severe SCFEs.